No mandatory HPV vaccine, what about an AIDS vaccine?

Since writing a story for today’s paper about the incidence of HPV in the United States, I’ve been thinking about vaccines for sexually transmitted diseases.

Philadelphia Inquirer

The controversial vaccine.

State Rep. Jessica Farrar, D-Houston, who is involved in the legislative dispute surrounding the HPV vaccine in Texas recently pointed out to me this truism about the state’s politics: There’s a huge stigma about HPV being a sexually transmitted disease. People freak out about sex. It’s always a difficult subject in a conservative state like Texas.

The issue is giving a vaccine to sixth-grade girls, which might be construed as condoning pre-marital sex. I can certainly understand this from a moral perspective. And, although I haven’t talked to my wife about this, I will want my daughter to have the vaccine when she enters the sixth grade.

I’m wondering, however, what would happen if a similarly effective vaccine were developed for HIV?

Cervical cancer kills about 3,700 women a year. AIDS kills four times as many women, about 15,000 Americans a year, and not all of them acquired the HIV virus through sexual contact or illicit drug use.

So the question, then, is how would Texas lawmakers handle a vaccine for HIV if, say, it had to be administered to kids around the sixth grade? Would a mandatory vaccine be similarly opposed by present critics of the HPV vaccine?

111 Responses

“The issue is giving a vaccine to sixth-grade girls, which might be construed as condoning pre-marital sex.”

I think the people who DON’T have pre-marital sex are probably something like 5-10% of the population. The girls are going to do it anyway, regardless of whether they receive a vaccine for ONE PARTICULAR STD. There are still a dozen more out there which they are not protected against.

I think the real problem is that Gov. Perry did this out of the blue, with unilateral action. He declined to lead on the subject. He did not sell it, he attempted to impose it by executive order.

I happen to agree with the idea of mandatory innoculations for any widespread disease when every it is practical.

The success reactionaries have had in calling this cancer a sexually tranmitted disease is astonishing. But this kind of turmoil is what happens when someone does not lead well.

Alternate media has done many things well and has made a big difference in widening the public square in this country. But alternate media is made of people, and people, whether in tradtional media or new are subject to prejudices, poorly analyzed positions, and being flat out wrong.

That’s not the issue, and I’m getting sick and tired of commentators blaming some mythical conservative fear of sex. The real concerns that have been raise (instead of presumed) are: 1) the fact this vaccine is only one year old, 2) the cost associated with mandating a vaccine that does not prevent a contagion that is spread in a school setting, 3) the role of the drug manufacturer in pushing for mandatory vaccination, and 4) the Governor’s exceeding his authority in ordering it.

When the vaccine was first announced, I saw cartoons about how conservatives were going to prevent it from getting out. Total BS. Someone actually called Focus on the Family to get a comment, and it was “We think it’s a great idea — just let the parents decide”. Is that such a wrong thing?

I have school-age daughters, and my wife and I are still discussing whether have them vaccinated at a young age or not. Probably will, but is it unreasonable that we get to decide, instead of the government?

Eric, first off, the timing of the study (and the article) could be construed as supporting the vaccination program, even if that was not explicitly stated. Secondly I have to wonder who funded the study. Was Merck involved? If so again, this would appear to be part of a publicity campaign.

There are a number of issues that are killing the mandatory vaccination, not the least of which is the legislature’s anger at Perry doing an end run around them. Factor in the $306,000 that Merck has paid Perry over the last 6 years and the fact that his former chief of staff is now a lobbyist for them tends to indicate that Merck tried (and apparently succeeded) to buy this executive order. Yes, I’m saying it flat out. Perry’s executive order was bought and paid for and the man should be impeached for it.

But even ignoring the intercene politics and payoffs for the moment. There are valid philosophical as well as science issues here. The vaccine is very new. It has been tested for only 4 years and there is still no data about how long the immunity will last, nor what effect if any it will have on the fertility of the recipients. It has also shown to have some rare but serious neurological side effects.

NO vaccine has gone from approval to mandatory requirement that fast. Not even the chicken pox vaccine, which itself has problems in that it does not provide lifelong immunity as was originally thought and adults who catch chicken pox are more likely to die from it or have serious complications including sterility in men. And adulthood is when the immunity will be wearing off on the current crop of kids that have received it. If Gardasil has a similar problem of limited immunity, the whole school age vaccination program may be pointless. They will be losing their immunity just about the time they will be becoming sexually active.

There is also the cost factor, $360 is the lowball number I’ve heard for the series with some estimates as high as $900. That is a lot of money even for me, and I have insurance. I also have two daughters which will double my outlay as well.

There is also the issue that Gardasil only protects from 3 of the what? dozen or so strains that cause Cervical Cancer (and anal cancer as well as more rarely penile cancer). It is entirely conceivable that it will merely shift the percentage of infections to other strains which can still cause cancer. There is also another vaccine that is in the approval pipeline that covers I believe 14 different strains instead of the three, but if you start the Gardasil series and then decide you want the other vaccine, you have to start the shot series all over again. Another reason to wait until more data is known and the second generation vaccine is available.

There is the philosophical issue that mandatory vaccinations were intended to shut down transmission of disease at school, and unless school has changed A LOT since I was going, sexual transmission while at school should not be happening. There is also the concern that girls that have been vaccinated may think they are immune and will take chances that will lead to problems (pregnancy, other STD’s or even different strains of HPV that are not covered in the vaccine).

There is also the sexual bias in that only girls are being vaccinated but boys can be carriers, as well as suffer anal (for those who partake in that sort of thing) and more rarely penile cancers as a result of being infected. Would it not make sense that if herd immunity was the goal that carriers would be vaccinated as well?

I have no problem with an opt-in system. I have significant concerns about an opt-out one.

To speak to your second question, I would encourage anyone to get the HIV vaccine, if it ever materializes. Hopefully HIV will never mutuate or evolve into a more easily transmitted disease. If it does, we are in big trouble and vaccine issues will be a very low priority.

I think that Allen Reynolds and Rorschach have stated very clearly the problems and issues of the vaccine from the point of view of a lot of reasonable people.

I can not believe that people in this state think of this vaccine as something that will promote pre-marital sex. The idea is so completely ridiculous I can’t understand it. No one is saying that the vaccine prevents STDs. I don’t see any difference between this vaccine and a polio vaccine.

Your point about AIDS is a really good one. My sister and I were pondering that same question. We were also wondering: How would the public react if they were told that prostate cancer could be avoided if a vaccine was given to little boys before they became sexually active? Would they be as vehemently opposed to preventing cancer in men?

Hunter, the HIV vaccine if it ever comes about will have a downside. HIV tests look for antibodies to the virus. If you are vaccinated, you will have antibodies and will therefore test positive whether you have the disease or not, and since it will be difficult to tell whether a positive result is due to immunity or infection, it will be hard to gauge how well it is protecting you. You will most likely be banned from donating blood or tissues as well.

An HIV vaccine will not be the earth shattering news many think it will be. There will be significant drawbacks as well.

First of all, the study was funded by the National Center for Health Statistics, within the CDC. So it was the feds. As for the release of the study, no doubt this paper was submitted to JAMA more than a year ago, so the timing almost certainly is coincidental.

I can’t speak to the political motivations of Perry, but I agree that there’s a definite follow-the-money aspect to this story.

As for the vaccine itself, it’s been tested and approved by the feds. By itself that would probably be good enough for me, but most of the docs I have spoken to also say good things about Gardasil. The compelling argument for a vaccine mandate is building up herd immunity, but like I said, I can see where people would have issues with it.

Eric, Vioxx, Bextra, and Celebrex were approved by the feds too. Most docs are reading the same glowing literature that Merck has been pushing through all of the sales and media outlets, like the rest of us, they are only getting the positive spin. For that matter, the chicken pox vaccine, which I see as a looming health crisis, was tested as well. Therein lies the problem. FDA approval does not necessarily mean that the drug or vaccine is safe or effective, only that in the limited trials that it went through nothing seriously bad happened. Scale and time make all the difference in the world many times. You don’t start seeing the problems until it is rolled out to the general population. I’m a huge fan of vaccines, and I fully intend on getting my daughter vaccinated with one of the two (preferably the wider coverage one when it is approved) before she becomes sexually active and I intend on making it exceedingly clear to her what the vaccination means and what it does not. But that is MY choice to make. Not Merck’s and not Perry’s.

As to the timing of the study. Sorry, I’m finding it hard to believe that it is a complete coincidence that it is being released now, for the same reason I’m finding hard to believe it is a complete coincidence that Perry made a 180 degree about face within a month concerning a mandatory vaccination order just about the same time Merck paid him $6000 in their latest donation and after giving him $300,000 in the six years before. Merck pulled strings to get this study done and published when it was. Money and/or favors changed hands, you can count on it.

I am a computer systems analyst, an engineer and a father. I am not anti-vaccine, anti-establishment or anti established medical care. Nor do I believe that the vaccine will promote promiscuity. I am against mandatory requirements for a social disease.

I can only hope that as attentive parents, my wife and I impart sufficient common sense, proper values and a solid education to our son (Will) such that he will not engage in actions that are major risk factors of the human papillomavirus, or H.P.V., and cervical cancer: early age at first intercourse, multiple sexual partners and a partner with multiple previous sexual partners.

I see mandatory requirements for this vaccine as a sign that our society perceives good parenting to be failing. As another poster said, it’s *our* choice, we’re the parent s and we’re responsible for the health and safety of our own children, not the (well-meaning, perhaps, but misguided) state.

Surely it is not always the result of bad parenting when children do stupid things? being a teenager with those raging hormones… There comes a time when all the wise lessons from mum & dad get drowned out by the raging torrent of very different things… Why take the risk? Who is to say who IS a good parent anyway? We all like to think we do OK but maybe we’re just messing them up big time…

Doug, I had not seen your post when I made my first one, Eric must have been busy with the Merck salespeople at the time and hadn’t approved a whole mess of comments (I’M JOKING ERIC!). But like you I smell a dirty dollar in this. there is WAY too dang much money at stake here and Merck is pushing way too dang hard.

Of course there are differences, but cervical cancer kills women. That is a fact. Aren’t the lives of women worth the money? If this vaccine saved men I bet we wouldn’t be hearing so much opposition. That’s all I’m saying…

I will also point out that if you look at the demographic breakdown in the study, you cannot possibly miss the fact that people in married monogamous relationships have the lowest infection rate. 17%! and the peak infection rate is in the 20-24 year old range, 44% whereas the average of the other 4 age groups was only 26.15% If the immunity only lasts 10 years, by the time that these girls are hitting the peak infection years, they will no longer be immune. And I’d be willing to bet that if you looked a bit closer at the married subgroup, you’d find that the infection rate is tied to the infidelity rate.

The moral of this story is that people in monogamous relationships have a much smaller risk than those who sleep with any old thing that comes down the pike (or pole as the case may be.) and THIS is what we should be teaching our daughters, and we should be teaching this BY EXAMPLE. Stop screwing around, stop divorcing, and start thinking with something other than your genitalia. And maybe, just maybe, a whole lot of society’s problems might just go away.

Ni Hao! Happy Year of the Pig!Great Buddha! Here we go again. Forget the political arguments, the sociological arguments, the economic arguments, the religious and emotional arguments.Stick to basic science. There is no solid evidence that HPV or HIV is the CAUSE of cervical cancer or AIDS, respectively. There is only strong evidence that both CORRELATE with the respective diseases. Thinking regarding presence of HPV or HIV by a test must be qualified and dissociated from the actual disease and symptoms that it is CORRELATED with, e.g. cervical cancer and AIDS, respectively.Treatment of a CORRELATIVE phenomena that has not been established as CAUSE is a waste of time and resources as a target, and at the expense of diverting attention and funding away from seeking the real CAUSE, in this case, that of cervical cancer and AIDS.Mr. Rorschach “hit the nail on the head” regarding both HIV and AIDS. In contrast to simple viral-caused maladies like smallpox, polio where the actual virus has been clearly established according to Koch’s postulates as existent, present in all cases of symptoms, a vaccine has been clearly developed that blocks the virus and the symptoms in all cases, evidence justifying mandated vaccination, the presence of HIV is only established by already being immune to the virus, e.g. exhibiting antibodies to it, not the infectious virus itself.Immunity, e.g. the presence of antibodies, to HIV is insanely used as a diagnostic monitor of the need for anti-viral treatment, the need to be vaccinated against the cell culture artifact on which the virus is defined, and that one will die of AIDS sometime in the future if one is not treated against the virus and further “vaccinated.” How can HIV be the cause of AIDS when those who are predicted to get or already exhibit AIDS are already immune to HIV?HPV can be more directly diagnosed than HIV as a real presence in blood, the virus can be identified in individuals, and one can be successfully vaccinated to produce antibodies against HPV proteins in the blood, but this by no means that one has produced immunity to cervical cancer that causes death and suffering. What one calls harmless “cervical cancer” of the moment in general from a tissue sample estimated by the eye of a pathologist on how it “looks” rather than what it “is” must be distinguished from cervical cancer of the type that kills. There is currently no way to predict. Development and progression of any type of cervical cancer, harmless or the killer type, takes decades to emerge, and the vaccine was only recently developed. This alone says wait for even the CORRELATIVE data that says HPV presence CORRELATES to killer cervical cancer, and that vaccination CORRELATES with reduced incidence.MOTYR

Eric, If you want to know about medications, doctors are the place to go. You need to be talking to pharmacists. A doctor gets, on average 2 classes in pharmacology, while a pharmacist entire degree is focused on it. Doctors do not have to do any continuing education in pharmacology, pharmacists are required to take quite a bit. Your entire premise on the vaccination is a little offensive to those of us who oppose the mandatory vaccine. The only people saying it is being opposed for “moral reasons” are those that are supporting the vaccine. I beleive you have a straw man there.

“This is reality-check research,” said the study’s author, Lawrence Finer. “Premarital sex is normal behavior for the vast majority of Americans, and has been for decades.”

Finer is a research director at the Guttmacher Institute, a private New York-based think tank that studies sexual and reproductive issues and which disagrees with government-funded programs that rely primarily on abstinence-only teachings. The study, released Tuesday, appears in the new issue of Public Health Reports.

The study, examining how sexual behavior before marriage has changed over time, was based on interviews conducted with more than 38,000 people — about 33,000 of them women — in 1982, 1988, 1995 and 2002 for the federal National Survey of Family Growth. According to Finer’s analysis, 99 percent of the respondents had had sex by age 44, and 95 percent had done so before marriage.

Even among a subgroup of those who abstained from sex until at least age 20, four-fifths had had premarital sex by age 44, the study found.

Sex stable since the ’50s

Finer said the likelihood of Americans having sex before marriage has remained stable since the 1950s, though people now wait longer to get married and thus are sexually active as singles for extensive periods.

There are over 150 million females in the US population. 3700 will die of cervical cancer this year. In other words if you are female, you are more likely to get struck by lightning than die of cervical cancer.

Girls age 14 and under number over 29 million. In purley economic terms, why would you vaccinate over 29 million people to possibly save 3700 sometime in the future?

This vacine is being sold through fear-mongering.

What is the percentage of cervical cancer cases that are heredity related, and what is the percentage that are virus related? I expect the numbers for doing this become even less favorable.

Lastly, how many additional cases will the vacine cause in girls who would never have gotten cervical cancer if they were never vaccinated?

Hunter, I’m not saying that the vaccine should be put back on the shelf. If you read my post you read that I fully intend to get my daughters vaccinated before they become sexually active, but probably not with Gardasil, but with the second generation vaccine which should be approved in the next few months, and that is the key here. Merck is trying to tie up the market before the other vaccine hits. The other vaccine is far more effective because it covers far more strains, but even then, neither vaccine is realistically expected to give lifelong immunity. Vaccines tend to last about 10-15 years before the immunity wanes, and that is a VERY IMPORTANT POINT here. If you give the vaccine to a 9 year old, depending on the spacing between the boosters, you could expect her immunity to wane about the time she hits college which is THE WORST TIME FOR THAT TO HAPPEN. Granted that some girls become sexually active earlier than others (which brings a lack of parenting into the issue) but the average age is still around 16. All other philosophical issues aside for the moment, would it not make more sense to vaccinate incoming high school freshmen instead of 6th graders? By the time that series of boosters was finished, they’d be looking at not losing their immunity until well past the point that most have settled down to their first marriage (if not their second…). By that time they tend to be far less sexually promiscuous, which means their likelihood of becoming infected has gone down considerably.

Adults don’t generally get booster shots of anything, it just doesn’t happen. So a vaccine to protect against a disease which is a result of adult behaviors that wears off before the kid becomes an adult is not doing anyone much good now is it? Well, anyone except Merck…..

Hunter, I didn’t look for stats on being hit by lightning, which, I think off the top of my head, are about 1 in 80,000. Cervical cancer would be about 1 in 40,000 for women so you are right and I stand corrected.

If you want ot get your daughters vacinated, then you should do it, but there is no reason I should have to pay for something that makes no economic sense other than to enrich the vacine company if they can make it mandatory. I even expect the cost would come down if they are selling a huge amount more than is needed for such an insignificant problem – economically speaking.

From what I am reading in this post, their scare tactics are working.

Look, I have kids and love them dearly, as I know you love yours, but the vaccines for polio, smallpox, and the flu were developed because those diseases killed millions of people. The number of deaths from cervical cancer is insignificant in comparison. We’d be better off spending the money to make safer cars because 40,000 Americans die in auto accidents each year. (http://www.car-accidents.com/pages/stats.html)

One other question concerning this study Eric. I’ve been doing a little self-education here. There are something like 100 different strains of HPV, and about 30 of them are considered to be classified as sexually transmitted, and most of them clear on their own and have no noticeable syptoms. Only strains 16, 18, 31, 33, 35, 39, 45 and 51 can lead to the development of cervical dyskaryosis, which may in turn lead to cancer of the cervix. Gardasil only protects against 16 and 18 (it protects against 6 & 11 too but those cause genital warts, not cancer). Cervarix if and when approved will protect against 16, 18, 31, and 45.

How many of these women that tested positive were infected with these 8 magic strains? Was that data even compiled? or is this a lump sum of people who had one of the 30 STD strains, or is this a lump sum of people who had one of 100 different strains? Depending on which number we are discussing, it changes how this study is viewed.

There is the philosophical issue that mandatory vaccinations were intended to shut down transmission of disease at school, and unless school has changed A LOT since I was going, sexual transmission while at school should not be happening.

Rorschach, school has changed a lot since you and I were going.

Steve–FYI, the plural of “cervix” is “cervices”. Have you ever heard that word before? I haven’t.

When I got the oral polio vaccine at age 5, I snuck back behind the nurses and ate an extra sugar cube. For years afterward, I worried that I had taken an overdose of the vaccine.